Why Surgeon Coding and Facility Claims Must Match — The ASC Synchronization Problem Payers Are Now Auditing

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Ambulatory surgery centers (ASCs) are facing increasing pressure to keep professional and facility claims consistent. A surgeon may submit a professional claim for a procedure while the ASC submits a separate facility claim for the same encounter. Although these claims serve different billing purposes, the clinical details behind them should tell the same story. When surgeon coding and facility claims do not match, payers may see inconsistencies that can trigger claim reviews, payment delays, downcoding, or denials. The problem is not always an incorrect CPT code. Sometimes the issue is that two correctly prepared claims do not appear synchronized. The ASC Synchronization Problem ASC billing involves multiple parties. The surgeon or physician group submits the professional claim, while the facility submits the institutional claim for the services and resources provided by the ASC. Both claims can contain different codes because they represent different components of the same encounter....
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The Struggle of Primary Care Physicians with Dynamic Medical Billing Rules

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Medical Billing a Challenge for Struggling Primary Care Practices

Medical billing is a complex process and it’s always been a reason for the struggle of primary care physicians. In addition, their practice is often overwhelmed with constantly changing information, including protocols and billing codes which makes the situation more challenging.

When the covid-19 pandemic strains the U.S. healthcare system, primary care physicians were working to educate their patients, employ safety protocols, and handle large volumes of calls. This large volume of calls is creating administrative hurdles and operational challenges. Hence in response, many primary care practices are making changes to their medical billing processes to accommodate new patient needs.

The recent release of the Medicare physician fee schedule final rule from the Centers for Medicare & Medicaid Services (CMS) contains new hope for struggling primary care physicians and you will get to know about it in the following brief.

Add-on Code G2211

The CMS feels the need to compensate physicians and other qualified healthcare professionals for the inherent complexity of primary care and other office visits hence CMS is moving forward with add-on code G2211.

You may separately list this add-on code in addition to office/outpatient (E/M) visits for new or established patients (i.e. codes 99202-99215). Also, you can use this code even when the E/M visit is done via telehealth as this code is permanently added to the Medicare telehealth list by CMS. One important point you need to consider here is the code’s Medicare payment allowance will be approximately $15.88, but will vary geographically.

To know more about the struggle of primary care physicians with dynamic billing rules and examples that can help you to understand, click here: https://bit.ly/3ruoVyY Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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